Lumbar microendoscopic discectomy: Clinical results of 920 patients
Amitesh Dubey1, Nishtha Yadav2, Shailendra Ratre3, Vijay S Parihar3, Yad R Yadav4
1 Senior Resident, Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
2 Senior Resident, Department of Radiodiagnosis and Imaging, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
3 Assistant Professor, Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
4 Professor and Head, Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
Yad R Yadav
Professor and Head, Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Surgery in properly selected lumbar disk prolapse provides better early results than conservative management. Lumbar microendoscopic discectomy (MED) has been found to be associated with good results. We are reporting our experience of 920 consecutive patients using MED technique.
Materials and methods: Visual analog scale (VAS) scores for back pain and leg pain were recorded preoperatively and at 3, 6, and 12 months postoperatively. MacNab criteria were used to measure postoperative outcome. Indication for surgery was persistent leg pain despite 12 weeks of conservative management. The progressive neurologic deficit was also an indication for surgery. Disk prolapses associated with spinal instability and infections were excluded.
Results: The mean VAS score for leg and back pain before surgery was 7.6 and 2.4 respectively, which improved to 1.5 and 0.6 three months after surgery. There was a significant improvement in VAS scores for backache and radicular pain in 819 patients (89%) compared with preoperative values. About 91% patients had good-to-excellent results according to MacNab criteria. The average operative time and blood loss were 70 minutes and 20 mL respectively. Unilateral or bilateral symptoms were observed in 673 and 247 patients respectively. There were 14 recurrent disk surgeries. Accidental intraoperative single-facet injury, minor dural injuries, postoperative discitis, and root injury occurred in 5, 12, 5, and 2 patients respectively. The mean follow-up was 38 months.
Conclusion: Microendoscopic discectomy is an effective and safe alternate technique for lumbar disk disease.